Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

How to Reduce Obesity Rates, Increase HEDIS Quality Scores

January 19, 2017 - When attempting to improve provider performance on HEDIS quality scores, healthcare payers may need to pick and choose the quality measures that could be realistically raised. For example, childhood obesity may be one of the most common health conditions that pediatricians see. HEDIS quality measures call for screening Body Mass Index (BMI) and improving weight management among children as...


Articles

Why Payers Should Reduce Cost Sharing for High-Value Care

by

Today, more healthcare payers are positioning greater cost-sharing onto the consumers to keep from raising premium rates, according to commentary published in JAMA Internal Medicine. The 2016 National Health Insurance Survey discovered that 40...

How Payers, Providers Could Streamline Medical Claims Management

by

Successful medical claims management and processing is not always easy to garner for health insurance companies due to a lack of training among insurance agents, missing or inaccurate documentation, and the general time-consuming aspect...

4 Key Ways Payers Could Reach HEDIS Score Thresholds

by

Health payers looking to increase consumer satisfaction and member retention may need to reach care quality metrics and HEDIS measures. The National Committee for Quality Assurance (NCQA) is responsible for many aspects of HEDIS measures and...

How Healthcare Payers Could Reduce Wasteful Spending

by

For many years, the health insurance industry has been working to address wasteful spending among hospitals and medical practices. Some of the areas of wasteful spending relate to duplicative medical testing, unnecessary diagnostics, and excessive...

4 Ways Payers Could Improve Healthcare Price Transparency

by

Healthcare price transparency remains a key issue for health payers across the country. In order to strengthen member retention efforts especially during open enrollment periods, payers will need to boost price transparency to improve consumer...

How Payers Could Improve Population Health Management with Tech

by

When payers transition their reimbursement structures toward a value-based care payment model, healthcare quality improvement needs to be addressed. In order to boost quality, payers could target population health management and data analytics...

Key Ways Payers Could Improve Medical Claims Management

by

Medical claims management is a key aspect of the payer-provider relationship. However, medical claims management tends to include multiple challenges for both payers and providers. Some of the problems stem from a lack of training in medical...

Patient Engagement Helps Payers on Affordable Care Act Exchanges

by

Many health insurance companies selling health plans through the Affordable Care Act exchanges have been seeing higher and higher rates of financial losses. Some payers such as Aetna, Humana, and UnitedHealth Group have even pulled back from...

Health Payer Solutions for Improving HEDIS Quality Scores

by

Payers and providers transitioning to value-based care reimbursement need to commit to meeting and improving their HEDIS quality scores. However, the documentation involved in reporting HEDIS quality scores tends to become complex. Johns...

How Health Payers Could Help Reduce High Out-of-Pocket Costs

by

A major problem still impacting consumers within the health insurance market is the potential for seeing high out-of-pocket costs. Many individuals are still underinsured despite the significant decrease in the uninsured rate around the country...

Rise in High-Deductible Health Plans Requires Cost Transparency

by

High-deductible health plans are becoming more and more common across the health insurance industry. With the many changes that the Affordable Care Act (ACA) has brought, payers are attempting to control costs by offering more high-deductible...

Healthcare Payers Face Challenges with Medical Loss Ratio

by

Under the Patient Protection and Affordable Care Act’s medical loss ratio, health payers are required to spend a minimum of 80 percent of their premium revenue on paying claims and boosting quality while the rest (20 percent) can be spent...

3 Key Steps for Health Payers to Meet HEDIS Quality Measures

by

Health insurance companies are slowly moving toward adopting alternative payment models based on pay-for-performance metrics. This means more payers and providers are focused on meeting HEDIS quality measures. The scores payers receive on HEDIS...

How Payers Could Use Price Transparency to Boost Satisfaction

by

In order to reduce ever rising healthcare costs, health insurance companies will need to improve price transparency among their health plans as well as within their provider networks. The Robert Wood Johnson Foundation released a report showing...

How Provider Portals Streamline Medical Claims Management

by

Healthcare payers have often struggled to process claims and provide effective customer service in a more streamlined manner due to technological inefficiencies. Insurers have faced challenges with engaging both their consumer base as well as...

Data Analytics Key for Strengthening Employer-Payer Relationship

by

Health insurance companies, employers, and the workforce take a number of different steps to ensure that the best decisions are made in terms of health plan policies and covered benefits. For a variety of reasons, some businesses choose employer-sponsored...

High-Deductible Health Plan Consumers Seek Price Transparency

by

Families and individuals who have purchased healthcare coverage on the ACA health insurance exchanges may have seen that monthly premium rates are expected to rise 25 percent in 2017, but should be aware that those eligible for tax subsidies...

Top 4 Best Practices for Transitioning to Value-Based Care

by

With the healthcare industry continually reforming toward better patient outcomes and reduced medical spending, health insurance companies have been moving away from fee-for-service payment structures and adopting value-based care reimbursement...

Misalignment of Healthcare Quality Measures Impacts Payers

by

In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of financial penalties will be instituted for...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks